If male infertility is suspected, a semen analysis is performed. This test will evaluate the number and health of his sperm. A blood test can also be performed to check his level of testosterone and other male hormones.
If female infertility is suspected, your doctor may order several tests, including:
Two diagnostic tests that may be helpful in detecting scar tissue and tubal obstruction are hysterosalpingography and laparoscopy.
Infertility in Men Treatment
Any fertility treatment may be expected to have an effect on semen quality roughly three months after it is started, as this is the length of time required for a single cycle of spermatogenesis, or sperm production. If neither surgical nor medical therapy is appropriate, assisted reproductive technologies are possible.
In choosing a treatment plan, consideration should be given to each couple's long-term goals, financial constraints, and the results of the female partner's evaluation in addition to male factor findings.
The most successful medical therapy for male infertility involves reversing chemical, infectious or endocrine imbalances. This is called specific therapy, and it is usually successful because treatment is based on the correction of well-defined problems.
Examples of this include:
Another kind of treatment, called empiric therapy, attempts to correct rather ill-defined conditions. The use of clomiphene citrate, tamoxifen or ProXeed for low sperm density or motility are examples of this form of therapy.
These treatments often have limited success because the generally intact mechanisms within the body tend to counteract the intended effect. In other words, hormonal treatments based on the principle that "if some hormone is good, then more is better" are destined to failure and should be avoided.
Assisted Reproductive Technology
Treating specific illnesses may or may not treat the fertility problem. At least 10 percent of infertility problems are due to unknown causes and another 30 percent are due to problems in both the male and female partners.
In addition to medication and surgical infertility treatments to treat specific health conditions in men and women, a new class of treatments — called assisted reproductive technologies, or ART — has been developed. The most common ART is in vitro fertilization, or IVF, but new procedures can enhance the IVF process or address other infertility conditions. These procedures for men include:
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection, or ICSI, is a technique developed to help achieve fertilization for couples with severe male factor infertility or couples who have had failure to fertilize in a previous in vitro fertilization attempt. The procedure overcomes many of the barriers to fertilization and allows couples with little hope of achieving successful pregnancy to obtain fertilized embryos.
The procedure was first used at UCSF Medical Center in 1994 and the first successful birth achieved with ICSI assistance was in February 1995. UCSF Medical Center was the first San Francisco Bay Area program to achieve a pregnancy and birth with this "miracle" procedure.
The technique involves very precise maneuvers to pick up a single live sperm and inject it directly into the center of a human egg. The procedure requires that the female partner undergo ovarian stimulation with fertility medications so that several mature eggs develop. These eggs are then suctioned through the vagina, using vaginal ultrasound, and incubated under precise conditions in the embryology laboratory. The semen sample is prepared by spinning the sperm cells through a special medium. This solution separates live sperm from debris and most of the dead sperm. The specialist picks up the single live sperm in a glass needle and injects it directly into the egg.
Through the ICSI procedure, many couples with difficult male factor infertility problems have achieved pregnancy. Fertilization rates of 70 percent to 80 percent of all eggs injected are currently being achieved, and pregnancy rates are comparable to those seen with IVF in couples with no male factor infertility.
Sperm Extraction Procedures
Intracytoplasmic sperm injection has revolutionized the treatment of male infertility. The sperm requirement for egg fertilization has dropped from hundreds of thousands for in vitro fertilization (IVF), to one viable sperm required for ICSI when combined with IVF.
This has led to the recent development of aggressive new surgical techniques to provide viable sperm for egg fertilization from men with low or no sperm count. This also has pushed urologists beyond the ejaculate and into the male reproductive tract to find sperm. Presently, sources of sperm in otherwise azoospermic patients, or those with no ejaculated sperm, include the vas deferens, epididymis and testicle, using sperm aspiration techniques in which the sperm is suctioned from the organ.
Sperm aspiration techniques involve the use of minor surgical procedures to collect sperm from organs within the genital tract. These techniques are indicated for men in whom the transport of sperm is not possible because the ductal system that normally carries sperm to the ejaculate is absent, such as with the congenital absence of the vas deferens, or unable to be reconstructed.
Most recently, sperm has been fairly reliably extracted — 60 percent to 70 percent of the time — from the testes of men with sperm production problems of such severity that no sperm is found in the ejaculatory ducts.
It is important to realize, however, that IVF technology is required to achieve a pregnancy with the vast majority of these extraction procedures, and success rates are intimately tied to a complex and complementary program of assisted reproduction for both partners.
Sperm Extraction: Vasal Aspiration
Patients who have congenital or acquired obstruction of the ductal system at the level of the prostate or in the abdominal or pelvic portions of the vas deferens may be candidates for this technique. Patients who have undergone a vasectomy less than five years before also may be candidates.
Vasal aspiration is a brief, same-day operation under local anesthesia. It can be done through a small scrotal incision or through incisionless techniques. Either way, the vas deferens is entered and a syringe is used to suction leaking sperm into a nourishing fluid. More sperm are brought to the opening by gently massaging the epididymis and vas deferens. The recovery period is 24 hours. Aspirated sperm are specially processed and prepared for insemination or IVF.
Of the three extraction procedures, vasal aspiration provides the most "mature" sperm, as they have already passed through the epididymis, where maturation processes occur during normal sperm development. Often, ICSI is not required to achieve a pregnancy. A big benefit of vasal sperm is that it is basically equivalent to ejaculated sperm and thus it can be frozen at the time of surgery to avoid further procedures in the male.
Sperm Extraction: Epididymal Aspiration
Epididymal sperm aspiration can be performed in situations in which the vas deferens is either absent or is scarred from prior surgery, trauma or infection. Sperm are directly collected from a single, isolated epididymal tubule (MESA) or by blind needle puncture (PESA) in much the same manner as the vasal procedure. Depending on the length of the epididymis that is available for aspiration, multiple, separate aspiration attempts can be made from one or both testicles.
When 10 to 20 million sperm are obtained, the sperm are processed for fertilization of the partner's eggs. Epididymal sperm are not as "mature" as sperm that have traversed the entire length of the epididymis and reside in the vas deferens and, as a consequence, epididymal sperm require ICSI to fertilize eggs.
Egg fertilization rates of 60 percent to 80 percent and pregnancy rates of approximately 45 percent to 55 percent have been reported with epididymal sperm. Obviously, the results will vary among individuals because of differences in sperm and egg quality as well as the technical proficiency of the lab. Like vasal sperm, these sperm can be frozen at the time of surgery to eliminate future surgical sperm retrieval procedures.
Sperm Extraction: Testicular Sperm Extraction (TESE); Testicular Sperm Aspiration (TESA)
The newest of the aspiration techniques is testicular sperm retrieval. In this procedure, a small amount of testis tissue is taken by biopsy under local anesthesia. It is a breakthrough in that it demonstrates that sperm do not have to "mature" and pass through the epididymis in order to fertilize an egg. Because of their immaturity, however, testicular sperm need ICSI.
Testicular sperm extraction is indicated for patients in whom there is a blockage in the epididymis very near the testis that is either from prior surgery, infection or from birth, or a blockage within the ducts of the testes, called efferent ductules.
It also is used for men with extremely poor sperm production, in which so few sperm are produced that they cannot reach the ejaculate. Pregnancies are now routine in cases of poor sperm production, but there is some concern with the use of this sperm because in most cases the underlying condition causing the poor sperm production is still unknown. Therefore, in these cases, it must be realized that the condition which may have caused the infertility may be transmitted to the progeny.
Recently, even spermatids — round cells that eventually becomes sperm with tails — have been used to achieve pregnancies with ICSI. However, this has raised much speculation and concern about the use of genetic material from a still-evolving germ cell for clinical purposes before the system has been appropriately investigated and its genetic stability examined in animal models. Spermatid injections are currently considered experimental procedures.
One drawback of testis sperm is that is does not freeze as readily as epididymal or vasal sperm, so it is more likely that the male partner will need to undergo repeated procedures for each IVF attempt.
Sperm Extraction: "Mapping" the Failing Testes
First proposed in 1997, this concept addressed the issue of how to detect where ICSI-compatible, mature sperm exist within failing or atrophic testes. It was based on prior observations that sperm production can be "patchy" or "focal" within the failing testis. This led to the idea that the more sites that are sampled within the testis to look for sperm, the higher the chances of usable sperm.
Information derived from "mapping" can be used as follows:
Intrauterine insemination or IUI, as commonly known, can be considered as the first line of treatment for infertility. IUI can be useful for both male and/or female factor related infertility. Typically, indications for IUI include-
It has been universally observed that whenever IUI is combined with induction of ovulation or controlled ovarian stimulation, the success rate in the form of pregnancy is improved.
Depositing actively motile sperm free from debris, leucocytes, pus cells, and dead sperm has a significant reproductive advantage in fertilizing the released oocyte from the ovary, in the fallopian tube. During natural intercourse, semen is deposited in the vagina, motile sperm from the semen move towards fallopian tube. Out of around 100 million sperm from a ‘normal’ man deposited in the vagina, only about 1 million sperm find their way to the upper portion of the uterine cavity and only few hundred enter the tube where fertilization occurs. In IUI, 5-10 million motile sperm are deposited at the top of the uterine cavity near the opening of the tubes thus significantly increasing the chances of healthy sperm reaching the mature oocyte.
The risk of infection with IUI is very small.
In Vitro Fertilization(IVF)
In 1978, PC Steptoe and RG Edwards successfully ‘created’ human embryo out side the body after fertilizing female gamete - the oocyte using male gamete- the sperm in a test tube. Though the patient underwent this treatment had blocked fallopian tubes, subsequently clinicians found that many other indications can be effectively treated by this innovative treatment modality.
Over the past 30 years, In Vitro Fertilization has seen many changes that include continuous refinement techniques, development of patient selection criteria, and patient preparation.
The IVF Program
Many couples willing to have their own child are still unable to become pregnant after first line therapy such as ovulation induction, intrauterine insemination, or reproductive surgery. For these couples, the next logical step is to explore the Assisted Reproductive Technologies (ART) like In Vitro Fertilization (IVF) popularly known as Test Tube Baby.
IVF is a technological process where several eggs are retrieved from a woman's ovaries and then fertilized by the husband's sperm outside the body in a controlled environment of the laboratory. The fertilized eggs then develop into embryos and these are returned to the woman's uterus, by a procedure called embryo transfer.
Indications for ART
Both Fallopian tubes are absent, blocked or hopelessly diseased.
The husband has a reduced sperm count(Oligozoospermia)
Sperms antibodies in wife's and /or husband's serum
Endometriosis i.e. the presence of endrometrium (lining of womb) outside the uterus.
Unexplained Infertility(refer to couples in whome no obvious pathology is found but who can not conceive.
IVF also helps women who have absent ovaries or where there are no eggs in the ovaries provided any young member of the family with proven fertility is willing to donate her oocytes.
We – at Fertility Clinic- have a dedicated team with more than 25 years of experience in he field of infertility and ART. We encourage you to learn as much as you can about the IVF program at our centre. This section of the Web site offers an overview of medications, procedures, success rates and financial issues related to IVF. You will also have the opportunity to tour our state-of-the-art medical facilities, post your querries you may have related to infertility.
It is necessary to take certain medications during the IVF cycle in order to prepare the body for the treatment. The instructions for each medication vary from patient to patient. The medical team at fertility clinic will analyze your case closely to determine which medications to use, what dosage to take, when to administer the medications and how long to take them.
The Preliminary Investigations are:-
1) Hysteroscopy & measurement of uterocervical length.
2) Ultrasound Examination of uterus and ovaries. To exclude uterine pathology and cyst in ovaries.
3) Hormonal Profile (TSH, Prolactin, FSH & LH on 3rd day of the period).
4) CBC, ESR, Blood VDRL, Blood Sugar PP, Blood group Rh factor, Australia Antigen/HIV /HCV antibodies Bleeding Time & Clotting Time, X-Ray chest & Chlamydia antibodies
1) Semen analysis.
2) Semen culture and antibiotic sensitivity test.
3) Antisperm Antibody test for husband and wife.
4) Sperm Survival test and semen harvesting.
5) Blood for Australia Antigen, HIV Antibodies, HCV Antibodies.
N.B.:- (1), (2) & (4) are valid for 3 months only.
High Risk Pregnancy
The factors that place a pregnancy at risk can be divided into four categories:
Existing Health Conditions
Conditions of Pregnancy
Are clots and thicker menstrual blood unusual during a period? continued...
Your body typically releases anticoagulants to keep menstrual blood from clotting as it's being released. But when your period is heavy and blood is being rapidly expelled, there's not enough time for anticoagulants to work. That enables clots to form.
If you have excessive clotting or clots larger than a quarter, you should see your health care provider to rule out any conditions that might be causing an abnormal period.
Are darker colors and thicker flows normal in menstrual blood?
Sometimes you may notice that your menstrual blood becomes dark brown or almost black as you near the end of your period. This is a normal color change. It happens when the blood is older and not being expelled from the body quickly.
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